thoughts on a situation?

[erin01]

So on my unit which is a busy tele unit, at night most of the nurses are young and inexperienced. Well one of the nurses who has been a nurse longer than me just not on this unit, had a confused patient. Now i stayed away for most of the night because i am pregnant and this patient at one point was trying to hit the nurses. He was pulling out his foley hitting and thrashing around in this bed. They restrained him and gave him ativan and haldol. The nurse kept calling the dr to get orders and by 5am she was a disaster, just exhausted and frustrated. I walked in close to 6 and the patient breathing was horrible, wheezing, abdominal muscles were being used. I asked her what his o2 sat was, and she said it was fine, and was at time trying to give him a breathing tx, by just holding the it over his face. IT was hard to administer because he was combative. He was not cyanotic, i looked at this finger nail beds and i have seen some one who really was not able to breath and i felt like he could. I asked if she thought maybe we should get a abg, like maybe he is hyperventilating? I felt something was off, but what do i know? One of the other nurses made a comment to her like about her doing nothing for this patient and his breathing all night! And i could tell how upset she got! I felt bad for her because i could see how it could happen, your so worried about his safety and and his behavior and thats what she thought was making him breath like that. Well the next day, the day nurses found out he was septic, fever of 103! Needless to say this nurse felt horrible, as did I for her. Especially because i would have done the same.. i think. I find it hard to be aggressive with patients like that, like i know something is off...but am not assertive to call a dr and say come see this patient now! I have seen these nurses who believe in how they feel and have no problem being aggressive in a situation like this! I am not one! I did pull this nurse a side and tell her not to beat herself up to much, because i know if she ever had a patient like that again it would go much differently!!!!!!!!! I just have had confused patients and its tuff, and its hard. She did mention that he was not confused at the beginning of the night and she thought maybe he was just sundowning. ITs so hard, we are not dr's and we are inexperienced! How to i become the one is confident enough to say something is wrong and get some one here now! Will i ever know when to do it? adv? thoughts ?

[twentytenRN]

Gut instinct has a place in nursing. More often than not, you should trust it. It makes you a good patient advocate.

Of note: Hypoxia=restlessness, agitation, confusion, etc... especially in the elderly!

[leslie :-D]

the more experience you get, the more confident you will become.

keep in mind also, that elderly typically do not present w/textbook s/s until the patho has advanced.

and, ms changes are often the first sign you will see.

give yourself time to grow into your role.

observe those nurses who you admire, and learn from them as well.

as for this pt, it can be challenging to assess any symptomology when you're trying to manage their escalated mental status.

it'll all fall into place, if you give yourself and time, a chance.

leslie

[canoehead, BSN, RN]

What a frustrating and exhausting situation. Exactly the scenario where a supportive coworker would make all the difference. Tell her she's doing a good job, and bounce ideas off each other, and see if they work. So you are both in it together, not the nurse that's responsible, and the nurse that walks by and makes a snide comment (what was she thinking?). It'll give the assigned nurse a second wind, and she'll be better able to step back and look at the behavior as a whole, not just try to put out fires while the patient tries to throw himself on the floor.

Start a good team interaction by observing that the pt is taking a lot of your coworker's time, and give her a break by taking turns answering the bell. Different approaches may get through to him when just one person can't. Ask about his history- you'll need to know if you answer his bell, and then if he doesn't settle in a decent amount of time you can talk about possible causes and solutions intelligently. Even if you don't fix the problem it will be an easier night for both of you, and a safer one for the patient.

When you know your coworkers have your back the work experience is a whole different world. Even if you have one buddy you can count on. Try to make that happen where you work, and tell people they are "not helpful" when if they undermine someone who is doing their best.